3 Maternal and Child Health Nursing i

PREFACE
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This learning packet is designed to assists students understand the

concepts, theories, and principles in the nursing care of children with
alterations in health status (Acute and Chronic). It incorporates learning
activities that will help students meet the objectives with the
corresponding textbook chapter.

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NCM 109 CARE OF THE MOTHER, CHILD AT RISK OR WITH
PROBLEMS (ACUTE AND CHRONIC)
Prepared by: BEGONIA C. YBOA, MAN

CONTENT
I. Nursing Care of Children with Alterations in Health Status (Acute and Chronic
A. Alteration on Oxygenation
a. Responses to Altered Cardiac and Tissue Perfusion
b. Responses to Altered Transport

INSTRUCTIONS:
This COURSE is divided into 4 learning packets (2 midterm period, and 2 final
Period). It is important for the student to acquire a textbook (see requirements). Access to the
internet is advantageous but in its absence, any Maternal and Child Health Nursing book
will suffice. Each topic includes an overview about the topic, along with student learning
objectives. Self-assessment questions and activities (SAQA) are provided. It is required that
students should answer all SAQA and Related Learning Experience (RLE) Activities (RLEA).
Answers should be handwritten on a separate notebook/journal. Students should acquire 4
or more notebooks (Cattleya )for the whole semester (4 learning packets/semester). It is
important that students accomplish the reading activity before proceeding with the
text/discussion. All activities in SAQA should be answered since this will be included as a
summative evaluation of student’s performance. Students should take note of the scheduled
retrieval of notebooks/journals. Late submission is tantamount to failing or incomplete grade
for the corresponding learning packet.

REQUIREMENTS:
• Textbook: Maternal and Child Health Nursing by JoAnne Silber-Flagg and Adele
Pillitteri or any Maternal and Child Nursing textbook published in 2010-present.
• 4 or more Learning Activity Notebook
Note: Write the following on the cover of your activity notebook
SURNAME, FIRST NAME, MI
YEAR SECTION- SUBJECT CODE (NCM103)
INSTRUCTOR: MS BEGONIA C. YBOA

GRADING SYSTEM:
Major Examination - 40%
Summative Quiz - 25%
Class Participation - 15%
Term Project/Requirements - 20%
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1.0 INTENDED LEARNING OUTCOME

Upon completion of thisNursi
learning packet, the student will be able to:
• Describe common cardiovascular disorders of childhood.
• Integrate knowledge of cardiovascular disorders with the interplay of nursing
process.
1.1 INTRODUCTION
Cardiovascular issues in children are complex, covering the spectrum from congenital
defects that may be present at birth to acquired heart disease or late onset-inherited
disorders. Since it is complex, nurses should have an in-depth understanding of the disease
processes, congenital heart defects, and treatments as well as the ability to work with children
of any age and families in varying states of emotional health.

1.2 Topics/Discussion
1.2.1. Alterations in Oxygenation
1.2.1.1. Responses to Altered Cardiac and Tissue Perfusion
1.2.1.2. Responses to Altered Transport

DISCUSSION

Responses to Altered Cardiac and Tissue Perfusion

• Tissue perfusion is crucial for organ functions such as the formation of urine, muscle
contraction, and exchange of oxygen and carbon dioxide.
• Sufficient tissue perfusion and oxygenation are vital for all metabolic processes in cells and
the major influencing factor of tissue repair and resistance to infectious organisms. The
concept of tissue perfusion is similar with blood flow, oxygen delivery or a combination of
flow and nutritional supply including that of oxygen. A concept covering both oxygen
delivery, tissue oxygen transport and oxygen consumption of the cells could be named tissue
oxygen perfusion. (https://pubmed.ncbi.nlm.nih.gov/7857061/).
• Tissue perfusion is further impaired by toxin-mediated platelet and neutrophil clumping that
cause vascular occlusion, further expanding the zone of devitalized tissue.

Impaired Tissue Perfusion

• The microcirculation is generally taken to include the smallest arteries, the arterioles,
capillaries, and venules. Exchange of gases, nutrients, and metabolites between the blood and
tissues occurs almost exclusively in the microcirculation, and adequate perfusion via the
microcirculatory network is essential for the integrity of tissue and organ function.
• Inadequate perfusion may underlie much of the tissue and organ dysfunction associated with
chronic conditions including hypertension, obesity, and diabetes mellitus.
(https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.107.763730).
Care of a Child with Cardiovascular Disorder
• Circulatory Changes at Birth:

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• When the umbilical cord is clamped, the blood supply from the placenta is cut off, and
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oxygenation must then take place in the infant’s lungs
• As the lungs expand with air, the pulmonary artery pressure decreases and circulation
to the lungs increases
• Structural Changes:
 Ductus venosus:
 after the umbilical cord is severed, flow through the ductus venosus
decreases and eventually ceases; it constricts within 3-7 days
 Foramen ovale
 Functional closure of this valve-like opening occurs when pressure in
the left atrium exceeds pressure in the right.
 Closure occurs within the first weeks after birth
 ·Ductus arteriosus
 Increase in aortic blood flow increases aortic pressure and decreases
right-to left-shunt through the ductus arteriosus.
 Functional closure occurs when this constriction causes cessation of
blood flow, usually 24 hours after birth.
 Anatomic closure by 1-3 weeks

SAQA-1
HOW DOES BLOOD FLOW THROUGH THE HEART?

Abnormal Circulatory Patterns after Birth

• Normal blood flow may be disrupted as a result of abnormal openings between the
pulmonary and systemic circulations.
• Any time there is a defect, blood will go from high to low pressure.
• Shunting
 Normally pressure is higher in the systemic circulation, so blood will be
shunted from systemic to pulmonary
 Left to right shunt
 With an obstruction to pulmonary blood flow, as well as an opening between
ventricles, the blood flow may be right to left

Nursing Care of Children with Cardiac Malformations

ASSESSMENT
• Health history
• Child’s current health status
• Visual assessment
• Physical Exam : apical impulse, thrills, lifts or heaves
o apical impulse, - point of maximal impulse (PMI) 4th-5th intercostal space,
midclavicular line in infants and children
 deviations in PMI can be an indicator of an enlarged heart due to illness,
HF of congenital heart defects
o FOUR BASIC HEART SOUNDS: S1, S2, S3, S4

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The most fundamental heart sounds are the first and second sounds,
Nursi usually abbreviated as S1 and S2. S1 is caused by closure of the mitral
and tricuspid valves at the beginning of isovolumetric ventricular
contraction.
 S2 is caused by closure of the aortic and pulmonic valves at the
beginning of isovolumetric ventricular relaxation.
 The third heart sound (S3), when audible, occurs early in ventricular
filling, and may represent tensing of the chordae tendineae and the
atrioventricular ring, which is the connective tissue supporting the AV
valve leaflets. This sound is normal in children, but when heard in adults
it is often associated with ventricular dilation as occurs in systolic
ventricular failure.
 The fourth heart sound (S4), when audible, is caused by vibration of the
ventricular wall during atrial contraction.
• Heart Murmurs in Children
o Types of murmurs include:
 Systolic murmur. A heart murmur that occurs when the heart contracts.
 Diastolic murmur. A heart murmur that occurs when the heart relaxes.
 Continuous murmur. A heart murmur that occurs throughout. the heartbeat.
o Other causes of murmurs include:
 Infection
 Fever
 Low red blood cell count (anemia)
 Overactive thyroid gland (hyperthyroidism)
 Heart valve disease
• Diagnostics
o Chest x-ray
o Cardiac fluoroscopy
o Echocardiogram
o Electrocardiogram
o Hematologic testing
o Cardiac catheterization
o Holter monitor
NURSING DIAGNOSES
 Activity intolerance related to imbalance between oxygen and demand
 Risk for disorganized infant behaviour related to pain and discomfort
 Body-image disturbance related to having a physical defect
 Risk for caregiver role strain related to caring for ill child
 Decreased cardiac output related to structural defect
 Altered family processes related to having a child with heart condition
 Altered growth and development related to inadequate oxygen and nutrients to tissues and
limited socialization with peers
 Risk for infection related to debilitated physical status
 Risk for injury (complications) related to cardiac condition and therapies
 Social isolation related to inability to participate in active play
PLANNING/IMPLEMENTATION
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 Correctly calculate the drug dosage (Digoxin)

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 Take apical pulse before administering the drug; withhold if below age norm
 Observe for signs of digitalis toxicity
 Teach the parents’ home administration of medications
 Help parents cope with symptoms of the disease
 Foster growth-promoting family relationships
 Preoperative assessment areas necessary for planning postoperative care
 Prepare the child physically and emotionally for surgery
 Specifics of postoperative care are similar to those for major surgery
 Help the child and family adjust to correction of the cardiac defect
EVALUATION
 Choose and participates in appropriate activities for age, energy, and developmental levels
 Consumes sufficient nutrients for growth and development
 Family and child discuss fears and feelings about disorder and limitations
 Family demonstrates home care for child

CONGENITAL HEART DEFECTS (CHD)

• A problem with the structure of the heart. It is present at birth.
• Congenital heart defects are the most common type of birth defect.
• The defects can involve the walls of the heart, the valves of the heart, and the arteries and
veins near the heart.
Assessment
• Physical assessment (color, pulse, respiration, blood pressure, chest auscultation).
• Family history.
• Pregnancy history.
• Assessment manifestations of congenital heart disease.
• Collagen tissue abnormalities.
• Complications or consequences of hypoxemia.
• Construction of a weak body.
• Dyspnea on activity.
• Fatigue.
Nursing Diagnosis for Congenital Heart Disease
• Risk for decreased cardiac output r / t defect structure.
• Altered Growth and Development r / t inadequate oxygen and nutrients to the tissues.
• Risk for infection r / t weak physical status.
• Altered family processes r / t have children with heart disease.
• Risk for injury (complications) r / t cardiac conditions and therapies.
Intervention
 Check the blood, red blood cell indices.
 Assess the arterial blood gas analysis.
 Test oxygen.
 Give afterload lowering medications as instructed.
 Give diuretic as instructed.
 Provide frequent rest periods and sleep periods without interruption.
 Encourage quiet activities.
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 Give a diet high in nutrients, which is balanced to achieve adequate growth.

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 Monitor height and weight.
 Encourage the family to participate in the care process.
 Teach families to recognize the signs of complications.
Expected Results
 Heart rate, BP and peripheral perfusion are the age-appropriate upper limit of normal.
 Exit adequate urine (between 0.5 and 2ml / kg, depending on age).
 Children achieve adequate growth.
 Families can confront the child with positive symptoms.
 Families recognize the signs of complications and take appropriate action. (https://free-
nursingcareplan.blogspot.com/2015/08/ncp-for-congenital-heart-disease.html)

Types of CHD
• Atrial Septal Defect
• Atrioventricular Septal Defect
• Coarctation of the Aorta*
• Double-outlet Right Ventricle*
• d-Transposition of the Great Arteries*
• Ebstein Anomaly*
• Hypoplastic Left Heart Syndrome*
• Interrupted Aortic Arch*
• Pulmonary Atresia*
• Single Ventricle*
• Tetralogy of Fallot*
• Total Anomalous Pulmonary Venous Return*
• Tricuspid Atresia*
• Truncus Arteriosus*
• Ventricular Septal Defect
o (*) are considered critical CHDs.
• Atrial Septal Defect (ASD)
o An atrial septal defect is a birth defect of the heart in which there is a hole in the wall
(septum) that divides the upper chambers (atria) of the heart.
o A hole can vary in size and may close on its own or may require surgery.
o The hole increases the amount of blood that flows through the lungs. A large, long-
standing atrial septal defect can damage your heart and lungs. Surgery or device
closure might be necessary to repair atrial septal defects to prevent complications.

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https://www.verywellhealth.com/atrial-septal-defect-asd-explained-3157206

• Heart defects present at birth (congenital) arise from errors early in the heart's development,
but there's often no clear cause. Genetics and environmental factors might play a role.
• Risk factors
o It's not known why atrial septal defects occur, but some congenital heart defects
appear to run in families and sometimes occur with other genetic problems, such as
Down syndrome.
o Rubella infection.
o Drug, tobacco or alcohol use, or exposure to certain substances.
o Diabetes or lupus.
• SIGNS AND SYMPTOMS
o Frequent respiratory or lung infections
o Difficulty breathing
o Tiring when feeding (infants)
o Shortness of breath when being active or exercising
o Skipped heartbeats or a sense of feeling the heartbeat
o A heart murmur, or a whooshing sound that can be heard with a stethoscope
o Swelling of legs, feet, or stomach area
o Stroke

Atrioventricular Septal Defect

• An atrioventricular septal defect (AVSD) is a heart defect in which there are holes
between the chambers of the right and left sides of the heart, and the valves that
control the flow of blood between these chambers may not be formed correctly.
• This condition is also called atrioventricular canal (AV canal) defect or endocardial
cushion defect.

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• two general types of AVSD

o Complete AVSD
 A complete AVSD occurs when there is a large hole in the center of the
heart which allows blood to flow between all four chambers of the
heart.
o Partial or Incomplete AVSD
 A partial or incomplete AVSD occurs when the heart has some, but not
all of the defects of a complete AVSD.
o Symptoms
 Arrhythmia, an abnormal heart rhythm.
 Congestive heart failure, when the heart cannot pump enough blood
and oxygen to meet the needs of the body.
 Pulmonary hypertension, a type of high blood pressure that affects the
arteries in the lungs and the right side of the heart.
o Treatment
 Surgery
 During surgery, any holes in the chambers are closed using patches.
 If the mitral valve does not close completely, it is repaired or replaced.

Patent Ductus Arteriosus

• Patent ductus arteriosus (PDA) is a medical condition in which the ductus arteriosus
fails to close after birth: this allows a portion of oxygenated blood from the left heart
to flow back to the lungs by flowing from the aorta, which has a higher pressure, to
the pulmonary artery.

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• Symptoms
o Poor eating, which leads to poor growth
o Sweating with crying or eating
o Persistent fast breathing or breathlessness
o Easy tiring
o Rapid heart rate
• Causes
o Congenital heart defects arise from problems early in the heart's development
— but there's often no clear cause.
o Genetic factors might play a role.
o In premature infants, the connection often takes longer to close. If the
connection remains open, it's referred to as a patent ductus arteriosus.
• Complications
o High blood pressure in the lungs (pulmonary hypertension).
Eisenmenger syndrome: an irreversible type of pulmonary
hypertension.
o Heart failure.
o Heart infection (endocarditis)
• Treatment
o Monitoring, medications, and closure by cardiac catheterization or surgery.
o Indomethacin or ibuprofen
o Furosemide

Ventricular Septal Defect

• a hole in the wall separating the two lower chambers of the heart.

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• A VSD is a hole in the wall (septum) that separates the 2 lower chambers of the heart
(right and left Nursi
ventricles).

• Pathophysiology
o Normally, the left side of the heart only pumps blood to the body, and the
heart's right side only pumps blood to the lungs.
o In a child with VSD, blood can travel across the hole from the left pumping
chamber (left ventricle) to the right pumping chamber (right ventricle) and
out into the lung arteries.
o If the VSD is large, the extra blood being pumped into the lung arteries makes
the heart and lungs work harder and the lungs can become congested.
• Symptoms
o With a larger opening, the heart and lungs have to work harder.
o This can cause symptoms such as :
 Tiredness
 Fast breathing
 Trouble breathing
 Pale skin
 Rapid heart rate
 Enlarged liver
 Poor feeding or tiring while feeding
 Poor weight gain
• Diagnosis
o Abnormal sound (heart murmur)
o Chest X-ray
o Electrocardiogram (ECG)
o Echocardiogram (echo)
• Treatment
o Medicine
o Good nutrition
o Supplemental tube feedings
o Surgery
o Cardiac catheterization
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Tetralogy of Fallot Nursi

• is a rare condition caused by a combination of four heart defects that are present at
birth (congenital).

• Four defects
o ventricular septal defect (VSD)
o pulmonary valve stenosis
 narrowing of the pulmonary valve and outflow tract or area below the
valve that creates an obstruction (blockage) of blood flow from the
right ventricle to the pulmonary artery
o a misplaced aorta
 the aortic valve is enlarged and appears to arise from both the left and
right ventricles instead of the left ventricle as in normal hearts
o a thickened right ventricular wall (right ventricular hypertrophy)
 thickening of the muscular walls of the right ventricle, which occurs
because the right ventricle is pumping at high pressure
• Symptoms
o loud murmur or cyanosis
o Rapid breathing
o arterial oxygen saturation: "tetralogy spell"
• Treatment
o Determining whether the child's oxygen levels are in a safe range
o Prostaglandin infusion
o Surgical intervention
o Complete repair
o Surgical correction:
 VSD: closure with synthetic Dacron patch
 The narrowing of the pulmonary valve and right ventricular outflow
tract is then augmented (enlarged) by a combination of cutting away
(resecting) obstructive muscle tissue in the right ventricle and by
enlarging the outflow pathway with a patch.

Congestive Heart Failure

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• Reflects the heart’s inability to meet the metabolic demands of the body
• Usually due toNursi
a surgically correctable structural abnormality of the heart that
results in increased blood volume and pressure.
•

• Etiology
o The primary cause of CHF in the first 3 years of life is CHD.
o Other causes in children include:
 Other myocardial disorders, such as cardiomyopathies, arrhythmias,
and hypertension
 Pulmonary embolism or chronic lung disease
 Severe hemorrhage or anemia
 Adverse effects of anesthesia or surgery
 Adverse effects of transfusions or infusions
 Increased body demands resulting from conditions such as fever,
infection and arteriovenous fistula
 Adverse effects of drugs, such as doxorubicin
 Severe physical or emotional stress
 Excessive sodium intake
 In general, causes can be classified according to the following:
 Volume overload may cause the right ventricle to hypertrophy to
compensate for added volume.
 Pressure overload usually results from an obstructive lesion, such as
COA
 Decrease contractility can result from problems such as severe anemia,
asphyxia, heart block and acidemia.
• Assessment
o Right ventricular failure
 Signs of right ventricular failure are evident in the systemic circulation
 Pitting, dependent edema in the feet, legs, sacrum, back, and buttocks
 Ascites from portal hypertension
 Tenderness of right upper quadrant, organomegaly
 Distended neck veins
 Pulsus alternans (regular alteration of weak and strong beats noted in
the pulse)
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 Abdominal pain, bloating

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 Anorexia,
 Fatigue
 Weight gain
 Nocturnal diuresis
o Left ventricular failure
o Signs of left ventricular failure are evident in the pulmonary system
o Cough, which may become productive with frothy sputum
o Dyspnea on exertion
o Orthopnea
o Paroxysmal nocturnal dyspnea
o Presence of crackles on auscultation
o Tachycardia
o Pulsus alternans
o Fatigue
o Pallor
o Cyanosis
o Confusion and disorientation
o Signs of cerebral anoxia

CARDIAC SURGERY
 Pediatric heart surgery
 Heart surgery in children is done to repair heart defects a child is born with
(congenital heart defects) and heart diseases a child gets after birth that need
surgery.
 The surgery is needed for the child's wellbeing.
THREE DIFFERENT TECHNIQUES
 Open-heart surgery is when the surgeon uses a heart-lung bypass machine.
o Heart-lung bypass machine
 Closed-heart surgery (thoracotomy)
 Cardiac catheterization

CARDIAC CATHETERISATION
 The insertion of a catheter into a vein or artery, usually from a groin or jugular
access site, which is then guided into the heart.
 This procedure is performed for both diagnostic and interventional purposes.

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 Diagnostic catheters are used to assess blood flow and pressures in the chambers of
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the heart, valves and coronary arteries, to assist in the diagnosis and management of
congenital heart defects.
 Interventional catheters are used as an alternative to open-heart surgery when
possible. These procedures include closure of septal defects (ventricular septal
defect device closures, atrial septal defect closure), expansion of narrowed passages
(pulmonary stenosis), stent placement, ablation of abnormal electrical --pathways
and opening of new passages (foramen ovale).
 Nursing Responsibilities
- vigilant monitoring of the patient after cardiac catheterization
- to promptly identify complications
- competent in the care of a patient

Rheumatic Heart Disease

 Rheumatic heart disease is the result of rheumatic fever caused by streptococcal
bacteria.
 Most likely to strike children between 5 and 15 years old, rheumatic fever can scar
heart valves to the point where they may not function properly.
 A complication of rheumatic fever in which the heart valves are damaged.
 Symptoms
o Sore throat
o Fever
o Painful, swollen and red joints
o Rashes
o Shortness of breath
 Diagnosis
o Throat culture, & blood test
o Physical Exam:
 joint pain and inflammation
 abnormal rhythms or murmurs
o Chest X-ray
o Echocardiogram
 Treatment
o Antibiotics
 Penicillin, or an equivalent antibiotic
 Aspirin
o Steroids

Kawasaki Disease
 Kawasaki disease causes swelling (inflammation) in the walls of medium-sized
arteries throughout the body
 The inflammation tends to affect the coronary arteries, which supply blood to the
heart muscle.
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 Kawasaki disease is sometimes called mucocutaneous lymph node syndrome

 Symptoms Nursi
o 1st phase
 A fever that is often is higher than 102.2 F (39 C) and lasts more than
three days
 Extremely red eyes without a thick discharge
 A rash on the main part of the body and in the genital area
 Red, dry, cracked lips and an extremely red, swollen tongue
 Swollen, red skin on the palms of the hands and the soles of the feet
 Swollen lymph nodes in the neck and perhaps elsewhere
 Irritability
o 2nd phase
 Peeling of the skin on the hands and feet, especially the tips of the
fingers and toes, often in large sheets
 Joint pain
 Diarrhea
 Vomiting
 Abdominal pain
 3rd phase
 In the third phase of the disease, signs and symptoms slowly go away
unless complications develop. It may be as long as eight weeks before
energy levels seem normal again.

Endocarditis
 The usual signs of endocarditis are prolonged fever for several days (occasionally up
to 30 days) in a child with congenital heart disease that occurs after a procedure in
the mouth, intestinal tract or urinary tract.
 However, the infection may occur without a previous procedure.
 Symptoms of endocarditis may develop slowly or come on suddenly. They include:
o Fatigue
o Fever
o Headache
o Joint inflammation or pain
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o Night sweats
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o Poor appetite
o Rash
 More severe symptoms
o Anemia
o An enlarged spleen
o Bleeding that causes small dark lines under the fingernails or small dark spots
on the skin
o New heart murmurs
 DIAGNOSIS
o Blood tests are key in diagnosing endocarditis and may be run to check the
erythrocyte sedimentation rate (ESR), get a complete blood count and conduct
multiple blood cultures to detect the bacteria.
o Depending on the signs and symptoms, tests to rule out other diseases may be
performed. In addition, your child's doctor may order the following tests:
 Echocardiogram to assess damage to the heart and large blood vessels
 Chest X-ray to check the size of the heart and look for signs of heart
failure
 Computed tomography (CT or CAT) scan to obtain a three-
dimensional image of the heart
 Treatment
o Antibiotics that are initially administered intravenously while your child is in
the hospital.
o If heart failure occurs, your child may need surgery to repair or replace the
affected heart valve.

Cardiomyopathy
 a form of heart disease in which the heart is abnormally enlarged, thickened and/or
stiffened.
 two general types of cardiomyopathy:
 ischemic cardiomyopathy
 Non-ischemic cardiomyopathy
 4 TYPES OF NONISCHEMIC CARDIOMYOPATHY
o Dilated Cardiomyopathy (DCM). It occurs when heart muscle tissue is
stretched and enlarged, making it difficult for the heart to function and often
causing congestive heart failure.
o Hypertrophic Cardiomyopathy (HCM)Excessive thickening of the heart
walls. Blood flow is restricted as the heart chambers become smaller and
stiffer.
o Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) —ARVC is
thought to be inherited and is usually found in teenagers or young adults.

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o Restrictive Cardiomyopathy (RCM) —RCM affects the ventricles — the lower

chambersNursi
of the heart — restricting blood flow to the heart. The cause of RCM
in children is not known.
Acquired Cardiomyopathy
 The most common cause of acquired cardiomyopathy is a viral infection called
myocarditis, which weakens the heart muscle. Other causes include:
o Infectious diseases
o Diseases that affect the immune system, such as HIV
o Nutritional deficiencies or obesity
o Exposure to toxins such as drugs, alcohol and radiation
o Pregnancy-related complications
 Symptoms
o Dilated Cardiomyopathy (DCM) — Symptoms in infants include difficulty
breathing, poor appetite and slow weight gain. Older children may also have
trouble being physically active and become excessively fatigued when
exercising.
o Hypertrophic Cardiomyopathy (HCM) — Infants with HCM often have
trouble breathing, may sweat excessively and have a poor appetite. Older
children may have shortness of breath, dizziness and chest pain. They also
may faint or have trouble being physically active.
o Restrictive Cardiomyopathy (RCM) — Although the symptoms of RCM tend
to be subtle, some children may have a poor appetite, tire easily, and
experience chest pain, an upset stomach and a dry cough.
o Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) — ARVC is very
rare in children and symptoms usually don't appear until the teen years or
late
 DIAGNOSIS
o A number of tests may be used to aid the diagnosis of cardiomyopathy as
well as to determine the type of the disease. These include:
 Echocardiogram
 Computed Tomography (CT or CAT) Scan or Magnetic Resonance
Imaging (MRI) —
 Electrocardiogram (ECG or EKG
 Holter Monitor
 Electrophysiology (EP) Study
 Radionuclide Ventriculogram Cardiac Catheterization
 Genetic Testing
 Prognosis for a child diagnosed with cardiomyopathy depends on the
type of cardiomyopathy they have as well as the stage of the disease.
 TREATMENT: The goal of treatment is to control or prevent congestive heart failure,
improve heart function and prevent complications, such as arrhythmias and blood
clots.
o Drug Therapy
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o Implantation of a Pacemaker or Defibrillator

o SurgeryNursi
o Heart Transplant

SAQA-2
I. Multiple choice. Read each question and answer choice carefully and choose the letter
with the best answer. Give the RATIONALE for your answer.
1. In fetal circulation the ductus venosus bypasses the:
a. Heart c. liver
b. Lungs d. placenta
2. Which diseases in the mother during pregnancy is an important clue to the diagnosis of
congenital heart disease?
a. Rheumatoid arthritis c. Streptoccocal infection
b. Rheumatic fever d. Rubella
3. Infants with congestive heart failure are positioned with the head elevated to promote:
a. Sodium restriction c. Fluid restriction
b. Sodium supplements d. Decreased caloric intake
4. The nutritional needs of the infant with congestive heart failure are usually:
a. The same as an adult’s
b. Less than a healthy infant’s
c. The same as a healthy infant’s
d. Greater than a healthy infant’s
5. Which of the following sets of assessment findings are the most frequent clinical
manifestations of a congenital heart disorder in an infant or child?
a. Decreased output and low blood pressure
b. Congestive heart failure and a murmur
c. Increased blood pressure and pulse
d. Dyspnea and bradycardia
6. One of the most important factors in preventing bacterial endocarditis is:
a. Administration of prophylactic antibiotic therapy
b. Surgical repair of the defect
c. Administration of prostaglandin to maintain patent ductus arteriosus
d. Administration of antibiotics after dental work
7. The peak age for the incidence of Kawasaki disease is in the:
a. Infant age group
b. Toddler age group
c. School-age group
d. Adolescent age group
8. Discharge teaching for a child with Kawasaki disease who received gamma globulin should
include which of the following instructions?
a. Peeling of hands and feet should be reported immediately
b. Arthritis, especially in the weight-bearing joints, should be reported immediately
c. Defer measles, mumps and rubella vaccine for 3 months

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 3 Maternal and Child Health Nursing i

d. All of the above should be included in the instructions

Nursi
9. Parents of the child with congenital heart defect, should know the signs of congestive heart
failure, which include:
a. Poor feeding
b. Sudden weigh gain
c. Increased efforts to breathe
d. All of the above
10. The most painful cardiac surgery for the child is usually the:
a. Thoracotomy incision site
b. Graft site of the leg
c. Sternotomy incision site
d. Intravenous insertion sites
II. Essay.
1. Describe how to help families decrease their fear and anxiety and increase their coping
behaviors when facing their child’s surgery to correct a congenital heart defect.

REFERENCES:

• Adele Pilliteri, Maternal and Child Health Nursing ; Lippincott, Williams,

and Wilkins, 2009
• McKinney, James, Murray, and Ashwill, Maternal and Child Nursing;
Elsevier Saunders, 2007
• Wong, Perry, and Hockenberry, Maternal and Child Nursing Care; Mosby
2002
• Lowdermilk, Deitra Leonard,Maternity and Health Care (8th ed.), 2004
• Klossner Jayne N.,Introductory Maternal and Pediatric Nursing, 2005
• White, Lois, Foundations of Maternal and Pediatric Nursing (2nd ed.) ,
2005
• Leifer, Gloria, Introduction to Maternity and Pediatric Nursing (5th ed.) ,
2007
• Luxner, Karla L.Delmar’s Maternal –Infant Nursing Care Plans (2nd ed.), ,
2005
• Schilling McCann, Judith A.Maternal-Neonatal Nursing Made Incredibly
Easy, , 2004
• Elaine and Marieb, Essentials of Human Anatomy and Physiology;
Pearson, 2004
• Snedden, R., Concise Medical Dictionary, 2010
• Chand, Ramesh, Nutrition and Dietetics2014
• Mosby, Medical Terminology, 2004
• Hockenberry, Marilyn J., Essentials of Pediatric Nursing (7th ed.), 2005
• Potter, Patrcia A.Fundamental of N , , 2005
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 3 Maternal and Child Health Nursing i

• Taylor, Carol, Fundamentals of Nursing (5th ed.), , 2005

• Nursi
Timby, Barbara, K., Essentials of Nursing Care of Adults and Children, ,
2005
• Ashalatha, PR.Textbook on Anatomy and Physiology for Nurses, 2006
• Gunstream, Stanley, E., Anatomy and Physiology (3rd ed.), 2006
• Raju, SM., Anatomy and Physiology for General Nursing, , 2006
• Seeley, Rod R., Essentials of Anatomy and Physiology (5th ed.), 2005
• Singh, Inderbir, Anatomy and Physiology for Nurses,, 2005
• Brown, Judith , Nutrition Now (4th ed.), 2005
• Peckenpaugh, Nancy J.,Nutrition Essentials and Diet Therapy (10th ed.),
2007
• Lehne, Richard A., Pharmacology for Nursing Care (5th ed.) 2005
• https://medlineplus.gov/ency/article/002398.htm
• https://americanpregnancy.org/pregnancy-
complications/trichomoniasis-during-pregnancy/
• https://www.cochrane.org/CD000225/PREG_topical-treatment-for-
vaginal-candidiasis-thrush-in-
pregnancy#:~:text=Vaginal%20candidiasis%20(moniliasis%20or%20thrus
h,is%20harmful%20to%20the%20baby.
• http://www.kastanis.org/uploads/0000/0013/CardinalMovements-
1.pdf
• https://www.ameda.com/milk-101-article/how-do-breasts-make-milk-
the-physiology-of-breastfeeding/

Acknowledgement
The images, figures and information contained in this learning packet were taken
from the references above.

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